Nutrition for healthy bones supports a longer, more active life

strong healthy bones

This series is for a slightly forgotten group, those of you who are gliding gracefully (or maybe disgracefully) through your forties or fifties. It’s never too late to change your diet to support a longer, more active life but if you do this in your forties your body will thank you later. Assuming you’ve got to grips with the general advice for adults about diet and health the 3 nutritional foundations for a longer, more active life are:

  1. Maintaining healthy bones
  2. Building and maintaining muscle mass
  3. Looking after your gut bugs and minimising inflammation

It’s a lot to take in so today I am going to focus on strong, healthy bones. If you have osteoporosis or osteomalacia, inflammatory bowel disease or coeliac disease please ask your Dietitian for specific, individualised advice.

The two most important food groups for bone health are dairy products and fruits and vegetables. So let’s start here.

Dairy products such as milk, yogurt and cheese are a great source of calcium which is essential for ongoing maintenance of bone health. Aim to have at least a couple of portions of dairy foods per day. For example milk with cereal or a yogurt or small piece of low fat cheese. Choose lower fat, unsweetened products – more on this later.

In addition to dairy foods good sources of calcium include:

  1. Pilchards, sardines and tinned salmon (but you need to eat the soft bones)
  2. Calcium fortified dairy alternatives like soya milk and yogurt (check that extra calcium has been added during manufacturing)
  3. Some breads and cereals which have had calcium added during manufacturing.

Other foods like wholemeal bread, chapattis, oranges, kale, broccoli and spring greens can also contribute but they contain much less calcium per serving. Many vegetables, beans, seeds and nuts that contain calcium also contain naturally occurring chemicals called oxalates and phytates. These substances make the calcium much less available to the body so if you are vegan I would strongly recommend seeking help from a Dietitian to ensure your diet is adequate.

Now I know some people have been confused and concerned by recent headlines about how we all need to halve our intake of dairy products. I will try to clear the fog because dairy foods should not be demonised!

Public Health England recently published the Eat Well Guide. This is a diagrammatic guide, designed to help people understand the proportions of different food groups that make up a healthy diet. If you get your protractor out you will note that an older version of the guide recommended that dairy foods should contribute about 15% of daily calories. The new guide recommends about 8%- hence the headlines.

So what’s this all about? Well one reason that the recommended proportion of calories from dairy has gone down is because the recommended proportion of calories from wholemeal and wholegrain carbohydrates has gone up. This is to ensure that we all get enough fibre (30g/day.) In addition there is concern that people are having way too many cappuccinos and lattes and these really pile on the calories and make us gain weight. So please remember that dairy foods are not dangerous they’ve just got a bit squeezed out and we need to choose dairy foods that are low in fat and sugar to keep our calorie intake down.

I think all the media coverage has got a bit out of hand and my advice is: “Put your protractors away.” Stop focussing on the percentages, cut back on processed fatty and sugary foods and simply have more fruit, veg and wholegrains/wholemeal products wherever possible whilst still including meat, fish, eggs, beans and pulses (peas and beans) for protein and dairy products for calcium.

The smaller you are, the lower your calorie requirements will be and the more difficult it will be to squeeze all the different recommendations about fibre, fruit and veg and calcium etc into your daily calorie allowance. This is nothing to panic about if your are smaller we can be more pragmatic about some of the recommendations. If you are keen on great nutrition and you don’t think the numbers stack up for you for whatever reason then make an appointment to see a Dietitian and look at a more individualised set of recommendations still based on good science.

One other thing to be aware of is that the Scientific Advisory Committee on Nutrition (SACN) is currently working on a report about dietary fat and health. One thing they are looking at really carefully is whether some saturated fats might be good for us whilst others might not be so good. Of course we don’t yet know what the conclusion will be because the research evidence the SACN is evaluating is complex. Whether or not the SACN conclude that dairy fat is OK, I have analysed enough diets to know that it is quite a challenge to get the recommended amount of calcium each day if dairy products are just 8% of total calories. Not impossible I must stress but it requires a lot of thought and it will be harder for women than men because we tend to be smaller and so need fewer calories i.e. less food overall. So even if saturates in dairy are shown to be OK for health ,we may still need to advise having low fat versions of dairy foods, in order to keep the calories down.

So what about fruit and veg? An intake of around 4 portions of fruit and 4 portions of vegetables each day is thought to be beneficial for bone health. Further research is needed but we already know that fruit and veg are good for cardiovascular health. So even though the evidence is weaker for bones it’s worth making the changes anyway if fruit and veg are not currently big in your diet. The 4 plus 4 recommendation is a bit more than the 5 a day message we usually hear in the UK. I know a, lot of people struggle to even manage 5 a day so aim for that and work your way up if you can but don’t beat yourself up if you can’t. Most people start with 1 portion of fruit or veg with each meal and 2 fruit or veg snacks per day. Once you’ve nailed that you can work up to 2 portions at each meal with 2 fruit or veg snacks. There is a very comprehensive list of fruit and veg portions on the NHS Livewell website at this link

Your Dietitian will be able to work with you to come up with a personalised plan to help you meet the goal. This will be based on your lifestyle and your likes and dislikes. Every plan is different and I always make sure people have lots of practical alternatives and recipes up their sleeves.

So what else do we need to think about for strong, healthy bones? Well vitamin D helps your body lay down calcium in your bones so that’s important. We make vitamin D when our skin is exposed to daylight but this can be a problem for people who don’t spend time outside. If you have dark skin it’s a bit more difficult for your body to do this. Whatever your skin colour it’s important to think about dietary vitamin D too:

  1. Oily fish such as salmon, sardines, pilchards, trout, kippers and eel contain reasonable amounts of vitamin D
  2. Cod liver oil contains a lot of vitamin D (don’t take this if you are pregnant)
  3. Eggs, meat and milk contain small amounts but this varies during the seasons
  4. Margarine, some breakfast cereals and some yoghurts have vitamin D added but you need to check the labels.

The other things I check when talking to clients about bone health are:

  1. Alcohol intake. It’s important to keep within the recommended 14 units/week
  2. Vitamin B12 and magnesium. Most of you will be getting enough magnesium from green leafy vegetables, beans, fish, seeds and wholegrains and enough vitamin B12 from eggs, milk, cheese, fish and shellfish and all these foods are good for your general health anyway. If you are vegan you will need to look for foods supplemented with vitamin B12.

Finally please don’t cut down on protein foods thinking they are bad for your bones whatever various internet and media “experts” might tell you! See another of my posts “the acid test” for more information. You really need protein for strong muscles too – more on that next time.

In the meantime grow older as disgracefully as you like but spare a thought for your health.

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